1
|
Chen N, Wang Y, Tang J. Free vascularized bone graft from the lateral epicondylar region of the humerus for treatment of scaphoid nonunion. Microsurgery 2024; 44:e31128. [PMID: 37877512 DOI: 10.1002/micr.31128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/17/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Free vascularized bone grafting (FVBG) has become one of the essential methods for treating scaphoid nonunion complicated by avascular necrosis. However, commonly used bone graft, including the medial femoral condyle bone graft and iliac crest bone graft, still present challenges such as a high rate of donor site complications and variations of vascular pedicle. In this study, we have introduced a novel bone graft-the lateral humeral condyle bone graft with the posterior branch of the radial collateral artery (PBRCA) as the vascular pedicle-as an alternative option, with the aim of overcoming some of the limitations of previously described FVBG procedures. METHODS Nine patients who had a nonunion of the scaphoid that had been present for an average of 16.8 months (range 9-35 months) were managed with use of a free vascularized bone graft obtained from the lateral humeral epicondylar region. Avascularity of the scaphoid, as assessed on preoperative magnetic resonance imaging and intraoperative bone marrow puncture test. Postoperatively, regular X-ray and CT scans examinations were conducted to assess the progress of fracture healing. Active motion of the wrist, and grip strength recovery were measured periodically. Wrist pain was graded using the Visual Analogue Scale (VAS), while wrist joint functionality was evaluated using the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) questionnaire and the Patient-Rated Wrist Evaluation (PRWE) scale. The elbow functional outcome was evaluated by the Mayo Elbow Performance Score (MEPS). RESULTS All of nine lateral humeral epicondylar bone grafts were successfully harvested. The blood supply of the graft during surgery was excellent in six cases and good in three cases. The size of the bone grafts ranges from 1.0 cm × 0.5 cm × 0.5 cm to 2.0 cm × 1.0 cm × 0.5 cm. The average vascular pedicle length was 3.4 cm (range 2.0-6.0 cm). There were no early complications in either the donor or recipient areas after surgery. Union was successfully achieved in all nine patients, with an average time to union of 14.3 weeks (range 11-20 weeks) after surgery. The average follow-up period was 31.2 months (range 26-40 months). At the final follow-up, the average palmar flexion, dorsal extension, radial deviation, and ulnar deviation angles of the injured wrist joint were 56.1° (range 45°-70°), 56.1° (range 40°-80°), 10.6° (range 5°-20°), and 22.2° (range 15°-35°), respectively, which reached 79.0%, 82.1%, 59.4%, and 72.8% of the average activity of the contralateral normal side. The average grip strength of the injured side was 35.2 kg (range 22-51 kg), which was equivalent to 81.3% of the average grip strength of the contralateral side. The average VAS score for wrist joint pain was 1.0 point (range 0-2 points); the Quick-DASH score was 9.2 points (range 6-18 points); and the PRWE score was 13.1 points (range 9-16 points), the Mayo Elbow Performance Index was 100 points (range 100-100 points). One patient reported a feeling of friction during movement but no pain. One patient reported numbness in the donor site. One patient complained of pain when applying force to the scar in the donor area. During the follow-up period, these complications showed improvement without any treatment. CONCLUSION The FVBG technique has been considered an effective method for treating scaphoid nonunion with avascular necrosis. Compared to traditional FVBG, the lateral humeral epicondylar bone graft exhibits a higher union rate, fewer complications, and easier accessibility, making it a favorable choice.
Collapse
Affiliation(s)
- Nuo Chen
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuling Wang
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Juyu Tang
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| |
Collapse
|
2
|
di Summa PG, Higgins G, Cotrufo S, Sapino G, Reekie T, Leonard D, Shaw-Dunn J, Hart A. Distal Brachial Artery Perforator flap: a new chimeric option for complex hand and digits defects. J Plast Reconstr Aesthet Surg 2021; 75:613-620. [PMID: 34728156 DOI: 10.1016/j.bjps.2021.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 06/11/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Reconstruction of fingers pose unique challenges, as a thin and flexible flap is needed in order to guarantee a good functional outcome. For the first time, in this report, we present the DBAp (distal brachial artery perforator) flap, based on the distal perforator closer to the medial epicondyle. The DBAp flap was used to reconstruct complex digit defects as free flap, and to cover an elbow defect while raised as a propeller. METHODS Four patients underwent finger reconstruction (free flaps): two patients presented an unstable finger scar following previous surgery, whereas the other two patients presented a terminalized finger at the level of the middle phalanx. A further patient presented a post-traumatic loss of substance at the elbow and was reconstructed using a perforator propeller DBAP flap. RESULTS Loss of tissues included skin and subcutaneous tissue in all patients and in one patient it included a bone component. Flap dimensions ranged from 48 to 18 cm2 (average: 32 cm2). Among complications, patient n.2 flap presented a marginal flap necrosis requiring a small skin graft after necrosis debridement. CONCLUSION The DBAp flap provides a slim, glabrous and pliable skin tissue with a well-hidden donor site scar and thanks to the anatomic location of the distal perforator can be designed to include a vascularized bone graft from the medial epicondyle. Despite the low number of cases, we believe that this flap should be considered as a dependable and effective source for complex reconstructions of both soft tissue and bone in fingers.
Collapse
Affiliation(s)
- P G di Summa
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G40SF, UK; Department of Plastic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, CH
| | - G Higgins
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G40SF, UK
| | - S Cotrufo
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G40SF, UK; Department of Plastic and Reconstructive Surgery, University of Messina, Messina, IT
| | - G Sapino
- Department of Plastic and Reconstructive Surgery, University of Modena, Modena, IT; Department of Plastic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, CH
| | - T Reekie
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G40SF, UK; College of Medical Veterinery & Life Sciences, The University of Glasgow, University Avenue, Glasgow, United Kingdom
| | - D Leonard
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G40SF, UK; College of Medical Veterinery & Life Sciences, The University of Glasgow, University Avenue, Glasgow, United Kingdom
| | - J Shaw-Dunn
- College of Medical Veterinery & Life Sciences, The University of Glasgow, University Avenue, Glasgow, United Kingdom
| | - A Hart
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G40SF, UK; College of Medical Veterinery & Life Sciences, The University of Glasgow, University Avenue, Glasgow, United Kingdom.
| |
Collapse
|
3
|
Zhang X, Yao Y, Rao L, Qin Z, Zhang L, Xu Y, Chen Y, Yao J, Song D. [Free sensate intercostal artery perforator flap for hand soft tissue reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:497-500. [PMID: 32291988 DOI: 10.7507/1002-1892.201904072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of free sensate intercostal artery perforator flap for the hand soft tissue reconstruction. Methods Between March 2010 and September 2015, 19 cases of hand soft tissue defect were repaired with free sensate intercostal artery perforator flap, including 16 males and 3 females, aged from 18 to 53 years, with an average of 35.2 years. The defect was located in the dorsum of the hand in 15 cases and in the palm in 4 cases. The causes of injury were traffic accident injury in 8 cases, hot crush injury in 5 cases, strangulation injury in 4 cases, and avulsion injury in 2 cases. All of them were full-thickness skin and soft tissue defects of hand with exposure of phalanges, tendons, blood vessels, and nerves. The size of defect was 10.0 cm×7.0 cm to 17.0 cm×8.0 cm. There were 12 cases of emergency operation and 7 cases of selective operation. The thickness of flap was 10-25 mm, and the size of the flap ranged from 10.0 cm×7.5 cm to 17.0 cm×8.0 cm. The vascular pedicle of the flap was anastomosed with the snuff nest branch of the radial artery (12 cases), the main radial artery (7 cases), and there accompanying vein, and the intercostal nerve cutaneous branch of the flap was anastomosed with the lateral cutaneous nerve of the forearm. The donor site was closed directly (14 cases) or repaired with medium thickness skin graft (5 cases). Results All of the flaps and skin grafts survived; the wounds in the donor and recipient sites healed by first intention. All 19 patients were followed up 10- 18 months, with an average of 12.7 months. After operation, the appearance and function of the hand recovered well, and there was no flap bloated. The two-point discrimination of the flap was 7-11 mm, with an average of 8.8 mm. Only linear scars left in the patients with direct closure of the donor site. The sensory function of the donor site was not significantly affected, and the hand function recovered satisfactorily. Conclusion Free sensate intercostal artery perforator flap is a valuable and reliable technique for the hand soft tissue defect.
Collapse
Affiliation(s)
- Xingqun Zhang
- Department of Hand Surgery and Plastic Surgery, the First People's Hospital of Yuhang District, Hangzhou Zhejiang, 311100, P.R.China
| | - Yi Yao
- Department of Hand Surgery and Plastic Surgery, the First People's Hospital of Yuhang District, Hangzhou Zhejiang, 311100, P.R.China
| | - Lei Rao
- Department of Hand Surgery and Plastic Surgery, the First People's Hospital of Yuhang District, Hangzhou Zhejiang, 311100, P.R.China
| | - Zhenbo Qin
- Department of Hand Surgery and Plastic Surgery, the First People's Hospital of Yuhang District, Hangzhou Zhejiang, 311100, P.R.China
| | - Longchun Zhang
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou Zhejiang, 310013, P.R.China
| | - Yibo Xu
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou Zhejiang, 310013, P.R.China
| | - Ying Chen
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou Zhejiang, 310013, P.R.China
| | - Jianmin Yao
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou Zhejiang, 310013, P.R.China
| | - Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| |
Collapse
|
4
|
Cheng D, Cui S, Zhang C, Li Y, Li H, Wang X, Wang J, Zheng L. [Effectiveness of medial ankle branches propeller "Tennis racket-like" flap in repair of heel-ankle tissue defects]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1450-1453. [PMID: 30417623 DOI: 10.7507/1002-1892.201804030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate effectiveness of the medial ankle branches propeller "Tennis racket-like" flap in repair of heel-ankle tissue defect. Methods Between June 2011 and June 2016, 50 patients with heel-ankle tissue defects were treated. There were 40 males and 10 females, with a median age of 35.6 years (range, 6-58 years). The defects were caused by trauma in 44 cases, scar deformity after trauma in 2 cases, chronic ulcer in 2 cases, and squamous cell carcinoma in 2 cases. The defects located at heel in 20 cases, ankle in 15 cases, and heel-ankle in 15 cases. The size of heel-ankle tissue defect ranged from 3.5 cm×2.0 cm to 13.0×10.0 cm. The course of disease ranged from 3 hours to 2 months (mean, 28 days). All wounds were repaired by the medial ankle branches propeller "Tennis racket-like" flap in a size of 3.8 cm×2.2 cm-13.4 cm×10.3 cm. The donor site was directly sutured in 5 cases or repaired by skin grafting in 45 cases. Results All flaps survived and wounds healed by first intention. Partial necrosis of skin grafting occurred in 1 case, and the wound recovered by change dressing. The other skin grafting survived and wounds healed by first intention. Forty-eight patients were followed up 12 months after operation. The appearance, sensory, and function of repaired heel-ankle flaps were satisfactory. Conclusion For heel-ankle tissue defect repair, the medial ankle branches propeller "Tennis racket-like" flap has advantages of the high survival rate, reliable blood supply, and sensory recovery.
Collapse
Affiliation(s)
- Ding Cheng
- Department of Burns and Plastic Surgery, Pingdingshan Traditional Pingmei Shenma Medical Hospital, Pingdingshan Henan, 467000, P.R.China
| | - Shuying Cui
- Department of Burns and Plastic Surgery, Pingdingshan Traditional Pingmei Shenma Medical Hospital, Pingdingshan Henan, 467000,
| | - Chengshu Zhang
- Department of Burns and Plastic Surgery, Pingdingshan Traditional Pingmei Shenma Medical Hospital, Pingdingshan Henan, 467000, P.R.China
| | - Yanling Li
- Department of Burns and Plastic Surgery, Pingdingshan Traditional Pingmei Shenma Medical Hospital, Pingdingshan Henan, 467000, P.R.China
| | - Heng Li
- Department of Burns and Plastic Surgery, Pingdingshan Traditional Pingmei Shenma Medical Hospital, Pingdingshan Henan, 467000, P.R.China
| | - Xiangling Wang
- Department of Burns and Plastic Surgery, Pingdingshan Traditional Pingmei Shenma Medical Hospital, Pingdingshan Henan, 467000, P.R.China
| | - Jun Wang
- Department of Burns and Plastic Surgery, Pingdingshan Traditional Pingmei Shenma Medical Hospital, Pingdingshan Henan, 467000, P.R.China
| | - Le Zheng
- Department of Burns and Plastic Surgery, Pingdingshan Traditional Pingmei Shenma Medical Hospital, Pingdingshan Henan, 467000, P.R.China
| |
Collapse
|
5
|
Wang H, Yang X, Chen C, Wang B, Wang W, Jia S. Modified Littler flap for sensory reconstruction of large thumb pulp defects. J Hand Surg Eur Vol 2018; 43:546-553. [PMID: 29433412 DOI: 10.1177/1753193417754191] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The Littler flap has been widely used to repair large pulp defects of the thumb; however, several complications have occurred frequently. In order to reduce these issues, the modified Littler flap innervated by the dorsal branch of the proper digital nerve and the proper digital nerve from the ulnar aspect of the middle finger or the radial aspect of the ring finger were devised in 16 consecutive cases. At the donor site, the defect of the proper digital nerve was repaired with a nerve graft from the proximal portion of the ipsilateral dorsal branch of the proper digital nerve. At the final follow-up, the scores for the static two-point discrimination test, Semmes-Weinstein monofilament test and total active motions in both recipient and donor fingers were nearly normal. This modified Littler flap provides a simple and reliable alternative for treatment of large defects of the thumb pulp with low donor-site morbidity. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Hui Wang
- 1 Hand Surgery Department, The Second Hospital of Tangshan, Tangshan, Hebei, PR China
| | - Xiaoxi Yang
- 2 The College of Traditional Chinese Medicine, North China University of Science and Technology, Tangshan, Hebei, PR China
| | - Chao Chen
- 3 The Department of Orthopedics, Chinese PLA General Hospital, Beijing, PR China
| | - Bin Wang
- 1 Hand Surgery Department, The Second Hospital of Tangshan, Tangshan, Hebei, PR China
| | - Wei Wang
- 1 Hand Surgery Department, The Second Hospital of Tangshan, Tangshan, Hebei, PR China
| | - Song Jia
- 1 Hand Surgery Department, The Second Hospital of Tangshan, Tangshan, Hebei, PR China
| |
Collapse
|
6
|
Badash I, Gould DJ, Patel KM. Supermicrosurgery: History, Applications, Training and the Future. Front Surg 2018; 5:23. [PMID: 29740586 PMCID: PMC5931174 DOI: 10.3389/fsurg.2018.00023] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 03/01/2018] [Indexed: 11/13/2022] Open
Abstract
Supermicrosurgery, a technique of dissection and anastomosis of small vessels ranging from 0.3 to 0.8 mm, has revolutionized the fields of lymphedema treatment and soft tissue reconstruction. The technique offers several distinct benefits to microsurgeons, including the ability to manipulate small vessels that were previously inaccessible, and to minimize donor-site morbidity by dissecting short pedicles in a suprafascial plane. Thus, supermicrosurgery has become increasingly popular in recent years, and its applications have greatly expanded since it was first introduced 20 years ago. While supermicrosurgery was originally developed for procedures involving salvage of the digit tip, the technique is now routinely used in a wide variety of microsurgical cases, including lymphovenous anastomoses, vascularized lymph node transfers and perforator-to-perforator anastomoses. With continued experimentation, standardization of supermicrosurgical training, and high quality studies focusing on the outcomes of these novel procedures, supermicrosurgery can become a routine and valuable component of every microsurgeon's practice.
Collapse
Affiliation(s)
- Ido Badash
- Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Daniel J Gould
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, United States
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, United States
| |
Collapse
|
7
|
Unglaub F, Langer MF, Unglaub JM, Müller LP, Hahn P, Spies CK, Löw S. Defektdeckung an den Fingern und am Daumen. Unfallchirurg 2018; 121:321-334. [DOI: 10.1007/s00113-018-0469-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
8
|
Dolderer JH, Geis S, Mueller-Wille R, Kelly JL, Lotter O, Ateschrang A, Prantl L, Schiltz D. New reconstruction for bone integration of non-vascularized autogenous bone graft with better bony union and revascularisation. Arch Orthop Trauma Surg 2017; 137:1451-1465. [PMID: 28825132 DOI: 10.1007/s00402-017-2775-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Phalangeal defects are often seen after tumor resection, infections, and in complex open hand fractures. In many cases, reconstruction is difficult and amputation is performed to avoid prolonged rehabilitation that is often associated with a poor outcome. In these cases, the maintenance of length and function presents a reconstructive challenge. METHODS We reviewed 11 patients who underwent extensive phalangeal reconstruction with non-vascularized bone graft from the iliac crest using a key-in-slot-joint technique to provide acceptable function and bony union. RESULTS In each case, non-vascularized bone graft with a length of 1.4-6.0 cm was used to reconstruct the phalanx. Follow-up ranged from 6 weeks to 5 months, and in all cases, there was bony union after 6 weeks. We evaluated range of motion, function, and as well pain and grip strength of the fingers. CONCLUSIONS This case series suggests that a key-in-slot technique allows non-vascularized bone graft to be used in complex large phalangeal bone defects. Due to better bone contact, a sufficient perfusion and revascularisation of the non-vascularized bone graft can be achieved for a quicker and stable bony union. This method appears to be an alternative to amputation in selected cases with a satisfactory soft-tissue envelope.
Collapse
Affiliation(s)
- J H Dolderer
- The Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.
| | - S Geis
- The Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - R Mueller-Wille
- The Institute of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - J L Kelly
- The Department of Plastic and Reconstructive Surgery, University Hospital Galway, Newcastle Rd., Galway, Ireland
| | - O Lotter
- The Department of Trauma Surgery, BG Trauma Center, University Hospital Tuebingen, Tuebingen, Germany
| | - A Ateschrang
- The Department of Trauma Surgery, BG Trauma Center, University Hospital Tuebingen, Tuebingen, Germany
| | - L Prantl
- The Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - D Schiltz
- The Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
9
|
Cheng D, Hu J, Cui S, Zhang J, Li D, Shi R, Xu L, Shou K. [Clinical observation of superficial branch of radial artery wrist crease flap for repairing ring tissue defect of fingers]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:837-840. [PMID: 29798529 DOI: 10.7507/1002-1892.201703096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness and operation method of the superficial branch of radial artery wrist crease flap for repair of ring tissue defect of the fingers. Methods Between June 2013 and March 2016, the superficial branch of radial artery wrist crease flap was used to repair ring finger tissue defect in 20 cases (21 fingers). There were 14 males and 6 females with an average age of 39.3 years (range, 12-61 years). The causes included machine injury in 9 cases, traffic accident injury in 6 cases, heat inury in 2 cases, and avulsed injury in 3 cases. The index finger was involved in 6 cases, middle finger in 6 cases, ring finger in 3 cases, and little finger in 6 cases. Combined injuries included exposure of bone, tendon, vessel, and nerve. The mean time of injury to operation was 3 hours (range, 0.5-5.5 hours) in 17 patients undergoing emergency operation, and was 8.5 days (range, 7-10 days) in 3 patients undergoing selective operation. The superficial palmar branch of the radial artery from the flap was used for bridging proper digital artery. The donor site was directly sutured in 19 cases and was repaired by skin grafting in 1 case. Results One case had blood blister at distal flap, which was cured after dressing change; the other flaps survived, and primary healing was obtained. Healing of incision at the donor site healed by first intention. The patients were followed up 6-24 months (mean, 12 months). The appearance, texture, and color of the flaps were satisfactory. The two-point discrimination ranged from 6 to 13 mm (mean, 9 mm) at 6 months after operation. According to the Chinese Medical Association Society of hand surgery of thumb and finger reconstruction function evaluation standard, the results were excellent in 13 cases, good in 4 cases, and fair in 3 cases; the excellent and good rate was 85%. Conclusion The superficial branch of radial artery wrist crease flap is an ideal choice for the repair of ring tissue defect of the fingers.
Collapse
Affiliation(s)
- Ding Cheng
- Department of Burns and Plastic Surgery, Pingdingshan Traditional Pingmei Shenma Medical Hospital, Pingdingshan Henan, 467000, P.R.China
| | - Junsheng Hu
- Department of Hand and Foot Microsurgery, Xuzhou Renci Hospital, Xuzhou Jiangsu, 221000,
| | - Shuying Cui
- Department of Burns and Plastic Surgery, Pingdingshan Traditional Pingmei Shenma Medical Hospital, Pingdingshan Henan, 467000, P.R.China
| | - Jichao Zhang
- Department of Hand and Foot Microsurgery, Xuzhou Renci Hospital, Xuzhou Jiangsu, 221000, P.R.China
| | - Dongfang Li
- Department of Hand and Foot Microsurgery, Xuzhou Renci Hospital, Xuzhou Jiangsu, 221000, P.R.China
| | - Rongjian Shi
- Department of Hand and Foot Microsurgery, Xuzhou Renci Hospital, Xuzhou Jiangsu, 221000, P.R.China
| | - Li Xu
- Department of Hand and Foot Microsurgery, Xuzhou Renci Hospital, Xuzhou Jiangsu, 221000, P.R.China
| | - Kuishui Shou
- Department of Hand and Foot Microsurgery, Xuzhou Renci Hospital, Xuzhou Jiangsu, 221000, P.R.China
| |
Collapse
|
10
|
Song D, Pafitanis G, Yang P, Narushima M, Li Z, Liu L, Wang Z. Innervated dorsoradial perforator free flap: A reliable supermicrosurgery fingertip reconstruction technique. J Plast Reconstr Aesthet Surg 2017; 70:1001-1008. [PMID: 28601599 DOI: 10.1016/j.bjps.2017.05.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 05/14/2017] [Accepted: 05/17/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION This study demonstrates the use of a modified free innervated DRAP flap utilizing the supermicrosurgery technique for fingertip reconstruction. MATERIALS AND METHODS From January 2010 to February 2014, 20 cases of fingertip reconstruction were performed using a short pedicle mini innervated transverse DRAP flap. The patients demographics, the mechanism of injury, the defect size and anatomical location, the source of pedicle vessels, the recipient vessels, the nerve branch used for innervation, the follow-up and sensation outcomes are reported. Three cases are presented demonstrating different anatomical fingertip injury reconstructions. RESULTS 20 consecutive traumatic fingertip injuries (M:F-14:6) were reconstructed with a free DRAP flap from the same hand. 6 index, 6 middle, 5 ring and 3 little finger defects were included in this study. All procedures were performed under regional anaesthesia and sedation. There were no intra- or post-operative complications. The average operative time was 105 (85-120) minutes. Each flap size was matching the size of the defects. All donor sites achieved primary closure and good cosmesis. The average follow-up was 12.8 (6-28) months. Follow-up demonstrated a static two-point discrimination of the flaps with an average distance of 5.5 (4-7) mm. CONCLUSION The innervated DRAP flap has proven to be an easy, reliable and effective sensate fingertip reconstruction option, utilizing the supermicrosurgery technique. LEVEL OF EVIDENCE Level IV, retrospective series.
Collapse
Affiliation(s)
- Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410000, China.
| | - Georgios Pafitanis
- The Royal London Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK.
| | - Peng Yang
- Department of Orthopedics Trauma Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai 200000, China.
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1138655, Japan.
| | - Zan Li
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410000, China.
| | - Linfeng Liu
- Department of Hand and Foot Surgery, Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan, Shandong 250000, China.
| | - Zengtao Wang
- Hand and Foot Surgical Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250000, China.
| |
Collapse
|